,i  #aacth ,,congress  #ast ,session    
,h4 ,r4 #efg  ,,in ,,the ,,house ,,of   
,,representatives  ,february #f1 #bjac  
,mr4 ,rokita 7for himself1 ,mr4         
,lamborn1 ,mr4 ,garrett1 ,mr4 ,scalise1 
,mr4 ,mulvaney1 ,mr4 ,huelskamp1 ,mr4   
,broun of ,georgia1 ,mr4 ,westmoreland1 
,mr4 ,radel1 ,mr4 ,ross1 ,mr4 ,poe of   
,texas1 ,mr4 ,holding1 ,mr4 ,hensarling1
 ,mr4 ,duncan of ,south ,carolina1 ,mr4 
,cotton1 ,mr4 ,culberson1 ,mr4 ,huizenga
 of ,michigan1 ,mrs4 ,black1 ,mr4       
,bucshon1 ,mr4 ,bishop of ,utah1 ,mr4   
,stewart1 ,mr4 ,fleming1 ,mr4 ,pearce1  
,mr4 ,austin ,scott of ,georgia1 ,mr4   
,la,malfa1 ,mr4 ,marchant1 ,mr4 ,roe of 
,tennessee1 ,mr4 ,palazzo1 ,mrs4        
,lummis1 ,mrs4 ,blackburn1 ,mr4 ,flores1
 ,mr4 ,gohmert1 ,mr4 ,amodei1 ,mr4      
,mc,henry1 and ,mr4 ,schweikert7        
introduced the following bill2 which was
 referred to the ,committee on ,energy  
and ,commerce1 and in addition to the   
,committees on ,ways and ,means1        
,education and the ,workforce1 the      

,judiciary1 ,natural ,resources1 ,house 
,administration1 ,rules1 and            
,appropriations1 for a period to be     
subsequently determined by the ,speaker1
 in each case for consideration of such 
provisions as fall within the           
jurisdiction of the committee concerned 
,a ,,bill  ,to amend the ,social        
,security ,act to replace the ,medicaid 
program and the ,children's ,health     
,insurance program with a block grant to
 the ,states1 and for other purposes4   
#a4 ,short title2 table of contents  7a7
 ,short title ,this ,act may be cited as
 the ,state ,health ,flexibility ,act of
 #bjac4  7b7 ,table of contents ,the    
table of contents of this ,act is as    
follows3  ,sec4 #a4 ,short title2 table 
of contents4 ,sec4 #b4 ,health grants to
 the ,states for health care services to
 indigent individuals4 ,title           
,,xxii--,,block ,,grants ,,to ,,states  
,,for ,,health ,,care ,,services ,,to   
,,indigent ,,individuals ,sec4 #bbja4   
,purpose4 ,sec4 #bbjb4 ,grants to       

,states4 ,sec4 #bbjc4 ,administrative   
and fiscal accountability4 ,sec4 #bbjd4 
,nondiscrimination provisions4 ,sec4    
#bbje4 ,emergency assistance4 ,sec4     
#bbjf4 ,definitions4 ,sec4 #c4 ,repeal  
of ,,ppaca1 ,,hcera1 and the ,federal   
requirements of ,medicaid and ,,chip4   
,sec4 #d4 ,severability4 ,sec4 #e4      
,effective date4  #b4 ,health grants to 
the ,states for health care services to 
indigent individuals  7a7 ,health care  
block grant to ,states ,the ,social     
,security ,act is amended by adding at  
the end the following new title3  ,,xxii
 ,,block ,,grants ,,to ,,states ,,for   
,,health ,,care ,,services ,,to         
,,indigent ,,individuals  #bbja4        
,purpose ,the purpose of this title is  
to provide ,federal financial assistance
 to the ,states1 in the form of a single
 grant1 to allow the ,states maximum    
flexibility in providing1 and financing 
the provision of1 health-care-related   
items and services to indigent          
individuals4  #bbjb4 ,grants to ,states 

7a7 ,in general ,subject to the         
requirements of this title1 each ,state 
is entitled to receive from the         
,secretary of the ,treasury a grant for 
each quarter of fiscal years #bjad1     
#bjae1 #bjaf1 #bjag1 #bjah1 #bjai1      
#bjbj1 #bjba1 #bjbb1 and #bjbc1 in an   
amount that is equal to #be percent of  
the total amount received by a ,state   
under title ,,xix and title ,,xxi for   
fiscal year #bjab4  7b7 ,appropriation  
,out of any money in the ,treasury of   
the ,united ,states not otherwise       
appropriated1 there are appropriated for
 fiscal years #bjad1 #bjae1 #bjaf1      
#bjag1 #bjah1 #bjai1 #bjbj1 #bjba1      
#bjbb1 and #bjbc such sums as are       
necessary for grants under this section4
  7c7 ,requirements relating to         
intergovernmental financing ,the        
,secretary of the ,treasury shall make  
the transfer of funds under grants under
 subsection 7a7 directly to each ,state 
in accordance with the requirements of  
section #fejc of title #ca1 ,united     

,states ,code4  7d7 ,expenditure of     
funds  7#a7 ,in general ,except as      
provided in paragraph 7#b71 amounts     
received by a ,state under this title   
for any fiscal year shall be expended by
 the ,state in such fiscal year or in   
the succeeding fiscal year4  7#b7 ,use  
of rainy day fund permitted ,of the     
amounts received by a ,state under this 
title1 the ,state may set aside1 in a   
separate account1 such amounts as the   
,state deems necessary to provide1      
without fiscal limitation1              
health-care-related items and services  
for indigent individuals during--  7,a7 
periods of unexpectedly high rates of   
unemployment2 or  7,b7 periods related  
to circumstances that are not described 
in subparagraph 7,a7 and that cause     
unexpected increases in the need for    
such items and services for such        
individuals4  7#c7 ,funds remaining     
after fiscal year #bjbb ,if1 after      
fiscal year #bjbc1 a ,state has funds in
 the account under paragraph 7#b71 the  

,state may only expend such funds if    
such funds are used in a manner that is 
permitted under subsection 7e71 as such 
subsection is in effect on ,september   
#cj1 #bjbc4  7e7 ,use of funds ,a ,state
 may only use the amounts received under
 subsection 7a7 as follows3  7#a7       
,general purpose ,for the purpose under 
section #bbja1 including the provision  
of health-care-related items and        
services as required under section      
#bbje4 ,nothing in this title shall be  
construed as limiting the flexibility of
 a ,state to determine which providers  
of such items and services qualify to   
receive payment from a grant made to the
 ,state under this title4  7#b7 ,funding
 for risk adjustment mechanisms ,to fund
 qualified high risk pools1 reinsurance 
pools1 or other risk-adjustment         
mechanisms used for the purpose of      
subsidizing the purchase of private     
health insurance for the high-risk      
population4  7#c7 ,authority to use     
portion of ,federal assistance for other

 welfare-related programs  7,a7 ,in     
general ,subject to the limit under     
subparagraph 7,b71 to carry out a ,state
 program pursuant to any or all of the  
following provisions of law3  7i7 ,part 
,a of title ,,iv of this ,act4  7ii7    
,section #afaf of this ,act4  7iii7 ,the
 ,food and ,nutrition ,act of #bjjh4    
7,b7 ,limitation ,a ,state may not use  
more than #cj percent of the amount     
received under subsection 7a7 for a     
fiscal year to carry out a ,state       
program1 or programs1 under subparagraph
 7,a74  7,c7 ,requirements on funds ,any
 amounts that are used under            
subparagraph 7,a7--  7i7 shall not be   
subject to any of the requirements of   
subsection 7d71 subsection 7f71 section 
#bbjd1 or section #bbje2 and  7ii7 shall
 be subject to--  7,i7 the audit        
requirements under section #bbjc2 and   
7,,ii7 any requirements that apply to   
,federal funds provided directly for    
such ,state program4  7f7 ,maintenance  
of current law restrictions on use of   

federal funds  7#a7 ,in general  7,a7   
,no funding for abortions ,none of the  
funds appropriated in this title shall  
be expended for any abortion4  7,b7 ,no 
funds for coverage of abortion ,none of 
the funds appropriated in this title    
shall be expended for health benefits   
coverage that includes coverage of      
abortion4  7,c7 ,health benefits        
coverage defined ,for purposes of this  
subsection1 the term health benefits    
coverage means the package of services  
covered by a managed care provider or   
organization pursuant to a contract or  
other arrangement4  7#b7 ,exceptions    
,the limitations established in         
paragraph 7#a7 shall not apply to an    
abortion--  7,a7 if the pregnancy is the
 result of an act of rape or incest2 or 
7,b7 in the case where a woman suffers  
from a physical disorder1 physical      
injury1 or physical illness that would1 
as certified by a physician1 place the  
woman in danger of death unless an      
abortion is performed1 including a      

life-endangering physical condition     
caused by or arising from the pregnancy 
itself4  7#c7 ,state funds used in      
conjunction with ,federal funds ,the    
limitations established in paragraph    
7#a7 shall apply to any ,state funds    
used in conjunction with ,federal funds 
appropriated under this title to        
provide1 or finance the provision of1   
health-care-related items and services  
to indigent individuals pursuant to     
section #bbja or subsections 7d77#b71   
7e77#a71 or 7e77#b7 of this section4    
7#d7 ,option to purchase separate       
coverage or plan ,nothing in this       
subsection shall be construed as        
prohibiting a ,state from purchasing    
separate coverage for abortions for     
which funding is prohibited under this  
subsection1 or a health plan that       
includes such abortions1 so long as such
 coverage or plan is paid for entirely  
using funds not provided by this title4 
7#e7 ,option to offer coverage or plan  
,nothing in this subsection shall       

restrict any health insurance issuer    
from offering separate coverage for     
abortions for which funding is          
prohibited under this subsection1 or a  
health plan that includes such          
abortions1 so long as--  7,a7 premiums  
for such separate coverage or plan are  
paid entirely with funds not provided by
 this title2 and  7,b7 administrative   
costs and all services offered through  
such separate coverage or plan are paid 
for using only premiums collected for   
such coverage or plan4  7#f7 ,conscience
 protections  7,a7 ,none of the funds   
appropriated in this ,act may be made   
available to a ,federal agency or       
program1 or to a ,state or local        
government1 if such agency1 program1 or 
government subjects any institutional or
 individual health care entity to       
discrimination on the basis that the    
health care entity does not provide1 pay
 for1 provide coverage of1 or refer for 
abortions4  7,b7 ,in this paragraph1 the
 term health care entity includes an    

individual physician or other health    
care professional1 a hospital1 a        
provider-sponsored organization1 a      
health maintenance organization1 a      
health insurance plan1 or any other kind
 of health care facility1 organization1 
or plan4  7g7 ,no funding for illegal   
aliens ,except as provided under this   
section and section #bbje1 no funds     
appropriated in this title may be used  
to provide health-care-related items and
 services to an alien who is not        
lawfully admitted for permanent         
residence or otherwise permanently      
residing in the ,united ,states under   
color of law4  7h7 ,nonentitlement      
,nothing in this title shall be         
construed as providing an individual    
with an entitlement to                  
health-care-related items and services  
under this title4  #bbjc4               
,administrative and fiscal              
accountability  7a7 ,audits  7#a7       
,contract with approved auditing entity 
,not later than ,october #a1 #bjad1 and 

annually thereafter1 a ,state shall     
contract with an approved auditing      
entity 7as defined under paragraph      
7#c77;,b77 for purposes of conducting an
 audit under paragraph 7#b7 7with       
respect to the fiscal year ending       
,september #cj of such year74  7#b7     
,audit requirement ,under a contract    
under paragraph 7#a71 an approved       
auditing entity shall conduct an audit  
of the expenditures or transfers made by
 a ,state from amounts received under a 
grant under this title1 or from ,state  
funds described in section              
#bbjb7;f77#c71 with respect to the      
fiscal year which such audit covers1 to 
determine the extent to which such      
expenditures and transfers were expended
 in accordance with this title4  7#c7   
,entity conducting audit  7,a7 ,in      
general ,with respect to a ,state1 the  
audit under paragraph 7#b7 shall be     
conducted by an approved auditing entity
 in accordance with generally accepted  
auditing principles4  7,b7 ,approved    

auditing entity ,for purposes of this   
section1 the term approved auditing     
entity means1 with respect to a ,state1 
an entity that is--  7i7 approved by the
 ,secretary of the ,treasury2  7ii7     
approved by the chief executive officer 
of the ,state2 and  7iii7 independent of
 any ,federal1 ,state1 or local agency4 
7#d7 ,submission of audit ,not later    
than ,december #ca1 #bjad1 and annually 
thereafter1 a ,state shall submit the   
results of the audit under paragraph    
7#b7 7with respect to the fiscal year   
ending on ,september #cj of such year7  
to the ,state legislature and to the    
,secretary of the ,treasury4  7#e7      
,additional accounting requirements ,the
 provisions of chapter #ge of title #ca1
 ,united ,states ,code1 shall apply to  
the audit requirements of this section4 
7b7 ,reimbursement and penalty  7#a7 ,in
 general ,if1 through an audit conducted
 under subsection 7a71 an approved      
auditing entity finds that any amounts  
paid to a ,state under a grant under    

this title were not expended in         
accordance with this title--  7,a7 the  
,state shall pay to the ,treasury of the
 ,united ,states any such amount1 plus  
#aj percent of such amount as a penalty2
 or  7,b7 the ,secretary of the         
,treasury shall offset such amount plus 
the #aj percent penalty against any     
other amount in any other fiscal year   
that the ,state may be entitled to      
receive under a grant under this title4 
7#b7 ,misuse of ,state funds ,if1       
through an audit conducted under        
subsection 7a71 an approved auditing    
entity finds that a ,state violated the 
requirements of section #bbjb7;f77#c71  
the ,state shall pay to the ,treasury of
 the ,united ,states #ajj percent of the
 amount of ,state funds that were used  
in violation of section #bbjb7;f77#c7 as
 a penalty4 ,insofar as a ,state fails  
to pay any such penalty1 the ,secretary 
of the ,treasury shall offset the amount
 not so paid against the amount of any  
grant otherwise payable to the ,state   

under this title4  7c7 ,annual reporting
 requirements  7#a7 ,in general ,not    
later than ,january #ca1 #bjae1 and     
annually thereafter1 each ,state shall  
submit to the ,secretary of the         
,treasury and the ,state legislature a  
report on the activities carried out by 
the ,state during the most recently     
completed fiscal year with funds        
received by the ,state under a grant    
under this title for such fiscal year4  
7#b7 ,content ,a report under paragraph 
7#a7 shall1 with respect to a fiscal    
year--  7,a7 contain the results of the 
audit conducted by an approved auditing 
entity for a ,state for such fiscal     
year1 in accordance with the            
requirements of subsection 7a7 of this  
section2  7,b7 specify the amount of the
 grant made to the ,state under this    
title that is used to carry out a       
program under section #bbjb7;e77#c72 and
  7,c7 be in such form and contain such 
other information as the ,state         
determines is necessary to provide--    

7i7 an accurate description of the      
activities conducted by the ,state for  
the purpose described under section     
#bbja and any other use of funds        
permitted under subsections 7d7 and 7e7 
of section #bbjb2 and  7ii7 a complete  
record of the purposes for which amounts
 were expended in accordance with this  
title4  7#c7 ,conformity with accounting
 principals ,any financial information  
in the report under paragraph 7#a7 shall
 be prepared and reported in accordance 
with generally accepted accounting      
principles1 including the provisions of 
chapter #ge of title #ca1 ,united       
,states ,code4  7#d7 ,public            
availability ,a ,state shall make copies
 of the reports required under this     
section available on a public ,web site 
and shall make copies available in other
 formats upon request4  7d7 ,failure ,to
 comply with requirements ,the          
,secretary of the ,treasury shall not   
make any payment to a ,state under a    
grant authorized by section #bbjb7;a7-- 

7#a7 if an audit for a ,state is not    
submitted as required under subsection  
7a71 during the period between the date 
such audit is due and the date on which 
such audit is submitted2  7#b7 if a     
,state fails to submit a report as      
required under subsection 7c71 during   
the period between the date such report 
is due and the date on which such report
 is submitted2 or  7#c7 if a ,state     
violates a requirement of section       
#bbjb7;f71 during the period beginning  
on the date the ,secretary becomes aware
 of such violation and the date on which
 such violation is corrected by the     
,state4  7e7 ,administrative supervision
 and oversight  7#a7 ,limited role for  
,secretary of ,treasury and the         
,attorney general  7,a7 ,treasury ,the  
authority of the ,secretary of the      
,treasury under this title is limited   
to--  7i7 promulgating regulations1     
issuing rules1 or publishing guidance   
documents to the extent necessary for   
purposes of implementing subsection     

7a77#c77;,b71 subsection 7b71 and       
subsection 7d72  7ii7 making quarterly  
payments to the ,states under grants    
under this title in accordance with     
section #bbjb7;a72  7iii7 approving     
entities under subsection 7a77#c77;,b7  
for purposes of the audits required     
under subsection 7a72  7iv7 withholding 
payment to a ,state of a grant under    
subsection 7d7 or offsetting a payment  
of such a grant to a ,state under       
subsection 7b72 and  7v7 exercising the 
authority relating to nondiscrimination 
that is specified in section #bbjd7;b74 
7,b7 ,attorney general ,the authority of
 the ,attorney ,general to supervise the
 amounts received by a ,state under this
 title is limited to the authority under
 section #bbjd7;c74  7#b7 ,federal      
supervision  7,a7 ,in general ,except as
 provided under paragraph 7#a71 an      
administrative officer1 employee1       
department1 or agency of the ,united    
,states 7including the ,secretary of    
,health and ,human ,services7 may not-- 

7i7 supervise--  7,i7 the amounts       
received by the ,states under this      
title2 or  7,,ii7 the use of such       
amounts by the ,states2 or  7ii7        
promulgate regulations or issue rules in
 accordance with this title4  7,b7      
,limitation on ,secretary of ,health and
 ,human ,services ,the ,secretary of    
,health and ,human ,services shall have 
no authority over any provision of this 
title4  7f7 ,reservation of ,state      
powers ,nothing in this section shall be
 construed to limit the power of a      
,state1 including the power of a ,state 
to pursue civil and criminal penalties  
under ,state law against any individual 
or entity that misuses1 or engages in   
fraud or abuse related to1 the funds    
provided to a ,state under this title4  
#bbjd4 ,nondiscrimination provisions    
7a7 ,no discrimination against          
individuals ,no individual shall be     
excluded from participation in1 denied  
the benefits of1 or subjected to        
discrimination under1 any program or    

activity funded in whole or in part with
 amounts paid to a ,state under this    
title on the basis of such              
individual's--  7#a7 disability under   
section #ejd of the ,rehabilitation ,act
 of #aigc 7#bi ,u4,s4,c4 #gid72  7#b7   
sex under title ,,ix of the ,education  
,amendments of #aigb 7#bj ,u4,s4,c4     
#afha et seq472 or  7#c7 race1 color1 or
 national origin under title ,,vi of the
 ,civil ,rights ,act of #aifd 7#db      
,u4,s4,c4 #bjjj;d et seq474  7b7        
,compliance  7#a7 ,if the ,secretary of 
the ,treasury determines that a ,state  
or an entity that has received funds    
from amounts paid to a ,state under a   
grant under this title has failed to    
comply with a provision of law referred 
to in subsection 7a71 the ,secretary of 
the ,treasury shall notify the chief    
executive officer of the ,state of such 
failure to comply and shall request that
 such chief executive officer secure    
such compliance4  7#b7 ,if1 not later   
than #fj days after receiving           

notification under paragraph 7#a71 the  
chief executive officer of a ,state     
fails or refuses to secure compliance   
with the provision of law referred to in
 such notification1 the ,secretary of   
the ,treasury may--  7,a7 refer the     
matter to the ,attorney ,general with a 
recommendation that an appropriate civil
 action be instituted2 or  7,b7 exercise
 the powers and functions provided under
 section #eje of the ,rehabilitation    
,act of #aigc 7#bi ,u4,s4,c4 #gid;a71   
title ,,ix of the ,education ,amendments
 of #aigb 7#bj ,u4,s4,c4 #afha et seq471
 or title ,,vi of the ,civil ,rights    
,act of #aifd 7#db ,u4,s4,c4 #bjjj;d et 
seq47 7as applicable74  7c7 ,civil      
actions ,if a matter is referred to the 
,attorney ,general under subsection     
7b77#b77;,a71 or the ,attorney ,general 
has reason to believe that a ,state or  
entity has failed to comply with a      
provision of law referred to in         
subsection 7a71 the ,attorney ,general  
may bring a civil action in an          

appropriate district court of the       
,united ,states for such relief as may  
be appropriate1 including injunctive    
relief4  #bbje4 ,emergency assistance   
7a7 ,in general ,a ,state that receives 
a grant under this title for a fiscal   
year shall provide payment for          
health-care-related items and services  
provided to a citizen1 legal resident1  
or an alien who is not lawfully admitted
 for permanent residence or otherwise   
permanently residing in the ,united     
,states under color of law1 consistent  
with the requirements of section #ahfg1 
if--  7#a7 such health-care-related     
items and services are--  7,a7 necessary
 for the treatment of an emergency      
medical condition2 and  7,b7            
health-care-related items and services  
that such ,state would provide payment  
for under this title1 if provided to an 
indigent individual2  7#b7 the          
individual meets all necessary          
eligibility requirements for            
health-care-related items and services  

under the ,state program funded under   
this title1 except for any requirement  
related to immigration status2 and  7#c7
 such items and services are not related
 to an organ transplant procedure4  7b7 
,emergency medical condition ,for       
purposes of this section1 the term      
emergency medical condition means a     
medical condition 7including emergency  
labor and delivery7 manifesting itself  
by acute symptoms of sufficient severity
 7including severe pain7 such that the  
absence of immediate medical attention  
could reasonably be expected to result  
in--  7#a7 placing the patient's health 
in serious jeopardy2  7#b7 serious      
impairment to bodily functions2 or  7#c7
 serious dysfunction of any bodily organ
 or part4  #bbjf4 ,definitions ,for     
purposes of this title3  7#a7           
,health-care-related items and services 
,the term health-care-related items and 
services shall be defined by a ,state   
with respect to use of such term for    
purposes of the application of this     

title to the ,state4  7#b7 ,high-,risk  
,population ,the term high-risk         
population means individuals who are    
described in one of the following       
subparagraphs3  7,a7 ,individuals who1  
by reason of the existence or history of
 a medical condition1 are able to       
acquire health coverage only at rates   
which are at least #aej percent of the  
standard risk rates for such coverage4  
7,b7 ,individuals who are provided      
health coverage by a qualified high risk
 pool4  7#c7 ,indigent individual ,the  
term indigent individual shall be       
defined by a ,state with respect to use 
of such term for purposes of the        
application of this title to the ,state4
  7#d7 ,qualified high risk pool ,the   
term qualified high risk pool has the   
meaning given such term in section      
#bgde7;g77#a77;,a7 of the ,public       
,health ,service ,act4  7#e7            
,risk-,adjustment ,mechanism ,defined   
,for purposes of this section1 the term 
risk-adjustment mechanism means any     

risk-spreading mechanism to subsidize   
the purchase of private health insurance
 for the high-risk population1 including
 a qualified high risk pool4  4  7b7    
,report on reduction of ,federal        
administrative expenditures ,beginning  
not later than ,october #ca1 #bjad1 and 
annually thereafter until ,october #ca1 
#bjbc1 the ,secretary of ,health and    
,human ,services1 in consultation with  
the ,secretary of the ,treasury1 shall  
submit a report to the ,committee on    
,energy and ,commerce in the ,house of  
,representatives and the ,finance       
,committee in the ,senate containing a  
description of the total reduction in   
,federal expenditures required to       
administer and provide oversight for the
 programs to provide health-care-related
 items and services to indigent         
individuals under this ,act1 compared to
 the expenditures required to administer
 and provide oversight for the programs 
under titles ,,xix and ,,xxi of the     
,social ,security ,act1 as in effect on 

,september #cj1 #bjab4  7c7 ,state      
defined ,section #aaja7;a77#a7 of the   
,social ,security ,act 7#db ,u4,s4,c4   
#acja7;a77#a77 is amended--  7#a7 in the
 first sentence1 by striking and ,,xxi  
and inserting ,,xxi1 and ,,xxii2 and    
7#b7 in the fourth sentence1 by striking
 and ,,xxi and inserting 1 ,,xxi1 and   
,,xxii4  #c4 ,repeal of ,,ppaca1        
,,hcera1 and the ,federal requirements  
of ,medicaid and ,,chip  7a7 ,,ppaca    
,the ,patient ,protection and           
,affordable ,care ,act 7,public ,law    
#aaa-adh7 is repealed1 and the          
provisions of law amended or repealed by
 such ,act are restored or revived as if
 such ,act had not been enacted4  7b7   
,,hcera ,title ,i and subtitle ,b of    
title ,,ii of the ,health ,care and     
,education ,reconciliation ,act of #bjaj
 7,public ,law #aaa-aeb7 are repealed1  
and the provisions of law amended or    
repealed by such title or subtitle1     
respectively1 are restored or revived as
 if such title and subtitle had not been

 enacted4  7c7 ,medicaid and ,,chip     
,titles ,,xix and ,,xxi of the ,social  
,security ,act are repealed4  #d4       
,severability ,if any provision of this 
,act1 or the application of such        
provision to any person or circumstance1
 is found to be unconstitutional1 the   
remainder of this ,act1 or the          
application of that provision to other  
persons or circumstances1 shall not be  
affected4  #e4 ,effective date ,this    
,act and the amendments made by this    
,act shall take effect with respect to  
items and services furnished on or after
 ,october #a1 #bjac4